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HomeMy WebLinkAbout18-026 {-` IDENTIFICATION NO. /5 - 7) 7--Le 1 r 1 (Office Use Only) Pea -fc.ai_ a city eek CITY OF IOWA CITY APPLICATION FOR TAXICAB/ MOTORIZED PEDICA6VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday— Friday) 410 East Washington Street Iowa City, Iowa 5 2240-1826 Failure to complete the "required"information will result in denial of the application (319) 356-5040 (319) 356-5497 FAX La§t 1. Name (REQUIRED) first t'16/ tif 2. Address(REQUIRED) (13 T)' ( fit / e- 114- 3. Contact Information(REQUIRED) Email: dM4'jf'4 S t-t4e7 • C drr—'e Cell Phone:3(9" -i- / I (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) i)/"//1.0 b. Taxicab Business Name (REQUIRED) 4l / `�1 5. Prior experience in transportation of passengers: (�/Ct.�`l6i `41/' !act a co 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When What happened tope charge?(Circle one) '" ConvictedDismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested/charged with any traffic offenses in the last five years? yt- Type of Qffense • Where When 44(4.66 � t' t y f ��o 0� - Wh ha ened td thech'ge?(Circle one) � � �c Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years'? "7c Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) A� DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW You must apply for an individual Department of Criminal Investigation Report(form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 A' • ' APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certi h v issued to me by the Iowa Dggpa ment of Transportation`a valid' ` Drivers license number © jp 7 e7)-) issued on 7//S/zc expiring on / #r . .a,2-' I understand that if I falsely answer any questions in this application, that this application may be denied. I agr at in making is application, I consent to allow agents or employees of the City of Iowa City, Iowa, in their discretion, tp exar`i e any a all records and documents relating to this application, and I further agree that, if authorization to be a*i603,drivereearanted,to comply at all times with all of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed1in frost of a Notary Public) ,(y �/r Signature of Applicant N� v /14 Datedb-(9//0 4)11,4 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by ----14.):cO 0 • 0•ec..tl i .. on this ZLP day of WENDY S.MAYER .,, 1.-.1-. �` t Commission Number 7284 9Iary 4i16. Public i nd for the State o owa riRon txptres *************************************************************************************A****k*AAAAA k**********AAAAAAAAAAAAAA A AA k****************** I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City(Title 5, Chapter 2, City Code). Expiration date •f Dr'�. -nse 12—IV Z-1 Signa . e of Police Chief or designee Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. .6c-,1,--461- ---6o —(-(p — V Signa re of City Clerk or d•signee Date *********************************************************************************************************************k************************** Office Use Only Approved application DCI report State certified driving record Website update Clerk/TAXIDRIVBADGEAPPL92014amended.DOC 07/2016 State of Iowa 41,401111. Division of Criminal Investigation l7ill nth /` 1` 215 E.7th Street � - !�,r Des Moines,Iowa 50319 i ii( IOWA IOWA �' Phone: 515/725-6066 Fax: 515/725-6080 = "'= ' tier Iowa Criminal History Record Check ' .+ Walk-In Request ii " Your name: p rt1 4 I 0 !41/4' %%(`J Address: 3 ` ' .r--P4 n City/State/Zip: //4 tt Lt 6( ' ,/1,- ,y,-- .5) / Fill in all shaded areas. Phone #: 7, 1 Ci ' V -9"/ — / .3—/ `( Requesting an Iowa criminal history record check on: Last Name Apelhdo(mandatory) First Name Primer Nombre(mandatory) Middle Name Segundo Nombre(recommended) iv 42-.,6 LIIV r b i-----/-0- Date of Birth Fecha Nacimiento(mandatory) Gender Genera(mandatory) Social Security Number(recommended) 1 .)--( 1 1 / n f ( 9 Male Female / tY2--00 -1930 Waiver Signatur Firma reskequest is on yourself,please sign. lithe request is on someone else,write N/A.) 0 `4_,,t 4,1 Results DCI USE ONLY As of • S ' ig , a name and date of birth check revealed: Ei ell n No record foundM , -r1 someen ilig Record attached DCI# ` '9 i /1..0- e.r, - :, DCI initials Q7.' j1 .Y^ goa - - uI? c) Receipt -s7 -. I (`� faa: Number of requests ! x $15.00 per last name= Total amount $ t ' v 1 Om Method of payment: cash money order check# MasterCard or Visa (Last 4 digits) Cardholder's na e DCI initials Credit Card # Exp. Date DCI-83 (09/09/10; Revised 10/1/10; form reviewed 08/1 1/14) IOWA CRIMINAL HISTORY DCI 00491790 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED- 2018/02/08 DCI:00491790 NAME: MAEGLIN,DAVID OTTO DOB SEX RAC HGT WGT EYE HAIR SKN POB 19591211 M W 511 185 GRN BRO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 19941122 AGENCY: IA0700100 MUSCATINE PD CHARGE NO- 01 IA STATUTE IA708-2A-2B SIMPLE DOMESTIC ABUSE TRK#: 012603801 COURT DISPOSITION AGENCY: IA070015J MUSCATINE CO DIST COURT COUNT NO- 01 IA STATUTE: IA708-2A-213 SIMPLE DOMESTIC ASSAULT TRK#: 012603801 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 6M 19950127 1111 02 ARRESTED/TAKEN INTO CUSTODY 20020214 AGENCY: IA0700000 MUSCATINE CO SO n r CHARGE NO- 01 IA STATUTE IA321J-2 n DD OWI 1ST d, rn 0 TRK#: 061312001 0 a..0 0 COURT DISPOSITION AGENCY: IA070015J MUSCATINE CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2 (A) OPER VEH WH INT (OWI) / 1ST OFF COURT CASE ID: 07701 OWCR023499 CHARGE CLASS: NON CONVICTION TRK#: 061312001 DRUNK DRIVING SCHOOL LICENSE REVOKED SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20020320 PROBATION 18M 20020320 COMMUNITY SERVICE 40H 20020320 DISCHARGED FROM 20031021 DEFERRED JUDGEMENT 03 ARRESTED/TAKEN INTO CUSTODY 20030615 AGENCY: IA0700000 MUSCATINE CO SO CHARGE NO- 01 IA STATUTE IA708.2A(4) DOMESTIC ABUSE 3RD TRK#: M00167401 COURT DISPOSITION AGENCY: IA070015J MUSCATINE CO DIST COURT • DCI 00491790 PAGE 2 OF 2 COUNT NO- 01 IA STATUTE: IA708.2A(2) (B) DOMESTIC ABUSE ASSAULT WITHOUT INTENT CAUSING INJURY COURT CASE ID: 07701 AGCR026983 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: M00167401 SENTENCE DISP EFF DAT TIME SERVED 2D 20030819 SUSPENDED JAIL 60D 20030819 JAIL 62D 20030819 FINE $250 20030819 PROBATION 18M 20030819 04 ARRESTED/TAKEN INTO CUSTODY 20040129 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124.401 (5) POSS CONTROL SUBSTANCE I _ min TRK#: 101070401 O 0) 0 m am. COURT DISPOSITION , IIMMO AGENCY: IA052015J JOHNSON CO DIST COURT XV n w COUNT NO- 01 IA STATUTE: IA124 .401 (5) O (D - M POSSESSION OF A CONTROLLED SUBSTANCE * v COURT CASE ID: 06521 SRCR067657 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 101070401 LICENSE REVOKED SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT SUSPENDED JAIL 30D 20040514 JAIL 30D 20040514 FINE $250 20040514 PROBATION 1Y 20040514 COMMUNITY SERVICE 25H 20040514 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON-LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. 0411 DIVISION OF CRIMINAL INVESTIGATION Arlilowa Department of Transportation sr+ Office d Driver Services (Td!Free)80G-532-1121 PO Box 9204,Des Moines,ILA 503O6 9204 515-2444124 FAX 515-239.1837 Certified Abstract of Driving Record Inquiry Date: 2/26/2018 DL/ID#: 059BB9825 (IA) Customer#: 1387263 Name: Maeglin, David Otto Class: D ID Status: None ��!! Address: 2038 DEERFIELD RD Audit#: 1300701 DL Status: VAL ■ r Issue Date: 09/15/2016 CDL Status: Non 71-^m m egeimm City/State: MUSCATINE, IA Expiration Date: 12/11/2021 CDL Cert Status: NoneS1) m rila 527618329 �C 1‘ Endorsements: Chauffeur 3 CDL Med Status: None s;) 6, Mailing Address: 2038 DEERFIELD RD Restrictions: Corrective Lenses Restriction None c Supplement: 0 R" Co) Date of Birth: 12/11/1959 Mailing MUSCATINE, IA Sex: M City/State: 527618329 History Information Convictions Citation Date Conviction Date ACD •Explanation County JUR 01/21/2016 02/04/2016 NO1 Fail to Yield Right of Muscatine IA Way Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 01/21/2016 903133 IA Name: Maeglin, David Otto DL/ID: 059BB9825 Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by the Office of Driver Services,that this is a true and accurate copy of an official record currently in the custody of said Office, and that I have been authorized by the Director of the Iowa Department of Transportation to so certify. In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: /M[ t 2/26/2018 1' IOWA p74466.01)44/004,47 Q. T. '. + Office of Driver Services Iowa Department of Transporation Name: Maeglin, David Otto DL/ID: 059BB9825 411111 G LQ tin c)